BMS Index 2024

The BMS Marketing Index assesses company standards on the marketing of breast-milk substitutes, hereinafter referred to as BMS products. These include any milks (or products that could be used to replace milk, such as fortified soya milk alternatives), in either liquid or powdered form, that are specifically marketed for feeding older infants and young children up to the age of three years. The 18 companies assessed on ATNI’s BMS Marketing Index 2024 represent 76% of the global BMS market.

A person’s first 1,000 days, or the period from conception until age two, are the most crucial for the development of their brain, body, metabolism, and immune system. Breastfeeding provides unparalleled brain-building benefits and gives infants the healthiest start to life. The World Health Organization (WHO) recommends exclusive breastfeeding up to six months of age, with continued breastfeeding along with appropriate complementary foods (CF) up to two years of age or beyond.

Inappropriate promotion of breast-milk substitutes (BMS) remains a threat to the protection and support of breastfeeding worldwide undermining informed choice among parents and caregivers and leading to suboptimal breastfeeding practice in high-income and low-income settings alike. Improving breastfeeding practices could save the lives of nearly 420,000 children and 90,000 mothers and prevent more than 4.6 million cases of childhood obesity globally each year. The 2023 Lancet series on breastfeeding estimated that USD 341.3 billion per year is lost globally from unrealized benefits to health and human development due to inadequate investment in protecting, promoting, and supporting breastfeeding.

For over a decade, ATNI has assessed how BMS companies comply with the 1981 International Code of Marketing of Breast-milk Substitutes (‘the Code’), which provides guidelines for the responsible marketing of BMS, including CF for infants and young children. ATNI’s research and Indexes do not assess compliance with local regulations or laws, but rather assess private sector performance against international standards and guidance.

In this iteration, ATNI has expanded the coverage to include the 20 largest companies in the global baby food segment – 11 additional companies compared to the last assessment in 2021.

Combined, the 20 companies hold an estimated share of at least 70% of the global baby food (BMS and CF) market. Eighteen of these companies that sell BMS products, contributing to at least 5% of their global baby food sales, are included in this BMS Index – and, together, these companies are estimated to cover 76% of the global sales of BMS products. This BMS Marketing Index 2024 assesses the quality of companies’ BMS marketing policies and management systems, their level of transparency, and their marketing practices in five global markets – China, Germany, Indonesia, Viet Nam, and the US.

Recommendations to BMS companies:

Companies should prioritize efforts to enhance and harmonize compliance with the Code across all countries they operate in, to protect optimal nutrition for infants and young children globally.

• Companies must fully align their policies and practices with the Code, including all subsequent relevant WHA resolutions up to WHA Resolution 71.9. Companies are especially urged to follow the guidance on ending the inappropriate promotion of foods for infants and young children, supported by WHA Resolution 69.9, to strengthen responsible BMS marketing practices in line with the Code.

• Based on ATNI’s findings, companies are encouraged to have explicit commitments and guidelines on responsibly marketing their BMS products in digital environments, in line with the latest guidance by WHO on restricting digital marketing of foods for infants and young children.
• Based on the results of the country studies, companies are urged to strengthen their policies and practices to address the inclusion of nutritional, health, and marketing claims on product labels in line with the Code.

• ATNI urges companies to uphold their BMS marketing commitments for all BMS products (including special purpose foods/ FSMPs) globally, and extend responsible marketing practices to GUMs, which constitute around 40% of global BMS sales.
• Companies that do not yet have a dedicated BMS marketing policy should develop and/or publish such policies that fully align with the Code. All companies are encouraged to refer to ATNI’s model company BMS marketing policy to see how they can comply with the Code in policy and practice.
• Companies should bolster their management systems to deliver consistent compliance with their stated commitments, once brought into full alignment with the Code.

• Companies should promptly take corrective actions upon receiving reports of incidences of non-compliance with the Code.
• ATNI urges companies selling products within the scope of the Code to take responsibility for monitoring their marketing practices beyond local regulations, according to the principles and the aim of the Code and subsequent relevant resolutions.
• Companies should publish more information on their BMS marketing policies and practices to increase transparency, and make key documents easily accessible to stakeholders.

Recommendations to investors 

As shareholders, investors play a significant role in shaping food companies’ governance, strategy, and disclosure practices.

• Investors should make use of existing models, such as ATNI’s model company BMS marketing policy, to integrate Code compliance into responsible investment strategies.

• Investors can use the findings of this Index to drive companies’ progress on responsible BMS marketing practices through various investment strategies, calling for transparency and compliance to the Code.
• Investors can use the data from this report to develop materials to support engagement with companies.
• Investors are urged to employ their influence to encourage companies to take steps towards full Code compliance.

Recommendations to policy makers 

Regulatory authorities should align local regulations more closely with the provisions of the Code, to address existing gaps and strengthen enforcement mechanisms.

• Digital marketing is challenging the ways in which national legislation is enforced and monitored. There is an urgent need to enforce regulations on digital marketing and introduce stronger legislation to monitor responsible BMS sale strategies. Ministries of information and communications and ministries of health should test new artificial intelligence applications for tracking Code violations online (e.g. such as VIVID, short for Virtual Violations Detector).

• We suggest that particular focus be placed on restricting parallel imports to countries and recommend the consideration of stricter rules to prevent the entry and marketing of parallel import products that do not comply with national regulations. The authorities could, perhaps, look at how the importation of these products might be more strictly controlled.
• The scope of national legislation should be expanded to encompass formulas intended for older infants and young children up to 36 months of age.

Recommendations to civil society and non-governmental organizations (NGOs) 

• Educational campaigns targeting consumers should be conducted to raise awareness on the importance of breastfeeding and the potential risks associated with inappropriate marketing of BMS products.
• NGOs, professional groups, institutions, and individuals can contribute by proactively reporting incidences of non-compliance with the Code to companies or distributors through available channels.

• NGOs, civil society, and academia can contribute to addressing current public health concerns by developing tools and means that support overall Code monitoring, enforcement, research, and adoption.